Medicare-certified home health agencies are undergoing ownership changes, raising concerns about healthcare spending, workforce, and quality of care. This is according to a study by UTHealth Houston published in JAMA Health Forum.
“The ownership change in health care sectors — including various forms of acquisitions by health systems, insurers, private equity firms, and other corporate investors — is increasingly reshaping U.S. health care system and causing concerns about quality of care,” said Yucheng Hou, PhD, assistant professor at UTHealth Houston School of Public Health. “Some types of the ownership changes, such as private equity firms’ acquisition of health care organizations, could shift organizations’ focus to short-term profit generating instead of providing high-quality care.”
This study is among the first to examine home health agencies specifically. Researchers analyzed 294 Medicare-certified home health agencies using data from 2016 to 2019 and compared them with 2,330 matched controls before and after ownership transactions.
In the three years following ownership changes, quarterly star ratings increased by 0.18 relative to controls. Greater increases were observed among agencies that transitioned from nonprofit/public to for-profit status. Per-capita payments from Medicare also rose within two years post-ownership change. However, sixty-day hospital admission rates and emergency department visits remained unchanged.
Hou noted that increased spending per patient might result from agencies shifting resources toward more profitable services or treating patients for multiple episodes following an ownership change.
“Although we find an increase in the home health star rating, this measure is mostly composed of self-reported quality measures from the home health agencies, so there might be room for upcoding,” Hou said. “The more objective claims-based quality measures, such as 60-day hospital admissions and outpatient emergency room visits did not change.”
A significant concern highlighted was staffing reductions: nurses decreased by 17% and home health aides by 26%. There was also a reduction in per-visit minutes for patients: down 5% for skilled nursing, 3% for physical therapy, and 11% for home health aide care.
“Overall our results are consistent with the growing evidence of corporate consolidation in other healthcare sectors which paints concerning implications of ownership changes on the quality of care,” Hou said.
Co-first authors were Zhanji Zhang from the University of Minnesota; Kun Li from Duke University; Siyi Wang from Rice University; and Shekinah Fashaw-Walters from the University of Pennsylvania.
